Trans-specific Surgeries

The information in this chapter is intended to outline the surgeries available to trans people wishing to medically transition sex, and the ways in which people can access these procedures in Québec. Your relationship with trans clients will benefit from you familiarizing yourself with the steps that trans people must take in order to gain access to these procedures and why many trans people either choose not to, or are unable to, obtain access.

There are so many individual gender identities, and priorities vary so greatly from person to person, that there is no “formula” for a gender transition. Some people have many of the surgeries, some people have none, and others have one or two. Factors that play a role in determining the ways in which people transition medically include choice, ability, overall health, financial status, and immigration status.

Access to Sex Reassignment Surgery in Québec

Some of the surgeries listed in this chapter are not currently covered or available in Québec. Some of them are also accessible and covered in other provinces in Canada.

Refugees and people covered for medical services under the Interim Federal Health Program cannot access trans-specific surgeries covered by the government in Québec until they apply and are accepted for Québec residency. The policy stipulates that a person must be a Québec Resident in order to be covered for access to trans-specific surgeries.

Before September 2009, all trans people wishing to access trans-specific surgeries in Québec had to pass through the program at the Human Sexuality Unit at the Montréal General Hospital. Since then, the manner in which trans people can access Sex Reassignment Surgeries (SRS) in Québec has changed. Publicly funded surgeries are being handled by a a private clinic, the Centre Métropolitain de Chirurgie Plastique in Montréal. Following a process of psychiatric evaluation, patients can present themselves directly to the clinic.

The requirements for accessing SRS in Québec are as follows:

  • Two letters of reference/evaluation from a psychiatrist, psychologist or sexologist, one of whom has seen the patient for at least six months, and the other of whom plays an evaluative role;
  • One letter from a doctor (an endocrinologist or family doctor) who is prescribing hormones (this is not a requirement for a double mastectomy/chest reconstruction surgery); and
  • One letter from a family doctor indicating good health of the patient.

Surgeries covered by the government of Québec include phalloplasty, metoidioplasty, vaginoplasty, double mastectomy with reconstruction, and hysterectomy. With the exception of hysterectomies, all the above listed surgeries, covered by the government, are done at the Centre Métropolitain de Chirurgie Plastique. Hysterectomies are accessed by trans men through regular channels, and not through this new method.

These procedures are fully covered for Québec residents only. Residency for permanent residents and citizens of Canada can be established after living in Québec for a period of three months. As it stands now, however, one cannot be reimbursed for surgeries done before September 2009, nor for surgeries done at other clinics.

Following is a list of surgeries that trans people might access over the course of their transition, including both surgeries which are covered in Québec and surgeries only accessible through the private sector.

Surgeries accessed by female-to-male transsexuals

SURGERY DESCRIPTION
Double mastectomy and reconstruction (top/chest surgery)This procedure involves the removal of the breast (bilateral mastectomy) and the construction of a male-appearing chest line.
HysterectomyThis procedure involves the removal of the uterus through one of three methods: abdominal incision, laparoscopically (by laser), or vaginally. The latter method is most commonly performed when the ovaries are not being removed at the same time.
MetoidioplastyThis procedure involves releasing the clitoris and allowing it to extend to its full length. This surgery results in a micro phallus (small penis). Some people also get their urethra extended, so that they can urinate through their penis. Testicular prostheses may also be implanted during surgery.
OophorectomiesThis entails the removal of the ovaries (and is often done in conjunction with a hysterectomy). This is one way to maintain a certain androgen level while decreasing the actual dosage of testosterone that is applied.
PhalloplastyA procedure that involves the construction of a penis.

Surgeries accessed by male-to-female transsexuals

SURGERY DESCRIPTION
Bilateral
orchiectomy
This involves the removal of the testes from the scrotum. Some people undergo orchiectomies in order to quit taking androgen blockers, or to place a stop to the testosterone production in their system. The scrotum is left in place, and can be used during further SRS.
Breast implants/augmentationThe surgeon inserts saline implants either over the pectoral muscles and under the glands, or under the pectoral muscle.
Cricothyroid
approximation (voice box surgery)
This surgery involves the tightening of the vocal cords. This surgery does not change voice intonation, nor does it make the voice higher. It simply raises the lower range to a higher range. Many people opt to get their Adam’s apple shaved (laryngeal reduction) at the same time.
Laryngeal
reduction (Adam’s apple shave)
This surgery can reduce the appearance of the Adam’s apple. A small incision is made over the Adam’s apple and the protruding thyroid cartilage is shaved and then sanded down to make it less visible.
VaginoplastyThis procedure is the surgical construction of a vagina. A labiaplasty may be performed at the same time or at a later date. In a labiaplasty, the minor labia can be created or refined, and the neoclitoris can be hooded.
Other surgeries that some trans people may deem necessary
• Facial feminization surgeries (nose, jaw, forehead and/or chin recontouring and cheek implants)
• Hair implants
• electrolysis/laser hair removal